(Rev. November 2017)
Department of the Treasury
Internal Revenue Service
|Request for Taxpayer
Identification Number and Certification
► a Go to www.irs.gov/FormW9 for instructions and the latest information
|Give Form to the
requester. Do not
send to the IRS.
|1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
|2 Business name/disregarded entity name, if different from above
|3 Federal tax classification:
||4 (You must file your w9 separately by mail to claim exemptions.)
|5 Address (number, street, and apt. or suite no.) See instructions
|City, state, and ZIP code
|7 List account number(s) here (optional)
||Taxpayer Identification Number (TIN)
|Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter.
|Social Security Number
Employer ID Number
|Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
|Signature of U.S. person